The National Institute of Medicine finally suggested that women obtain contraceptive care with full insurance coverage and without large co-pays. From one perspective, it was about time. Nearly half of all pregnancies are unintended and families should be expanded when there is true intent and not because contraception was not available. Also, since men have medications for erectile dysfunction covered by insurance, it's seemed only fair.

That stated, there might be a downside. Since no co-pays will be obtained, will the insurance companies increase payment to make up the difference (doubtful) or will the physician’s office loose the income in an already existing atmosphere of dwindling reimbursements (more likely)?

Will the frequency of unwanted pregnancies and abortions really fall? Even though condoms have been made available at some clinics for free, having the contraception easily available didn’t mean it was used at all or used correctly. When one provides something for free, is as appreciated as when one has to pay an amount, no matter how small, to increase personal responsibility?

When care becomes free or nearly free, there is almost always an increase in utilization. Is contraception one area of medicine that we would welcome increased utilization? Most, except the religions that do not believe in contraception, will agree this is ultimately a step in the right direction. Even so, there is no free lunch. Will insurance companies increase the premiums to pay for the office visits and the contraceptive medications and pass the costs to everyone else? We suspect the answer is probably yes.

At first glance, requiring insurance companies to pay for female contraception seems like a great idea but there is the issue of unintended consequences. Please share your thoughts on our Facebook pagewhere we've started the discussion. We’d love to hear from you!

Each year, physicians such as myself, fertility patients, their caregivers and families dedicated to raising awareness about the disease of infertility which affects 7.3 million Americans. RESOLVE, the national infertility association, has coordinated this week, April 24 through the 30 and we fully support it and encourage you to speak up in support as well. For information on how you can get involved in infertility awareness projects around the country and upcoming Advocacy Day on May 5, visit RESOLVE at www.resolve.org/takecharge.

At SRMS, we are committed to providing the highest quality care and support to patients and their families. Infertility is a disease, it is important and we are working to raise awareness on your behalf. For more information, visit www.dreamababy.comor call 239-275-8118.

Today, the good people of Mississippi will go to the polls to exercise their constitutional right to vote. One of the items they will cast their ballot on is Mississippi Ballot Initiative #26, which would give “personhood” to a fertilized egg. If enacted, this law will cause a chilling effect that will be felt throughout the infertility field as other states like Florida and Ohio, to name just two, gear up for similar referenda in 2012. The passage of Mississippi Initiative 26 will signal the start of a dangerous precedent, that if it gains momentum, will cause dire consequences for many of my patients.

This isn’t just about abortion, although this is what the proponents would like you to believe. Let me be clear, I don’t think the intention of the well-meaning individuals who may vote for this Initiative want to do harm. In fact, I am certain, people voting for the initiative probably feel they are saving lives. The problem is that Initiative 26’s proponents have not given the voters the right facts about the law’s devastating consequences in the state of Mississippi. The list of unintended consequences extends far and wide and involves women’s healthcare, the legal world and the infertile patient as well as the providers of their medical care.

Consequences to Women’s Healthcare

The following are very likely consequences of the passage of the amendment:

– The total outlawing of abortion, even in the cases of incest and rape.

– Outlawing of the vast majority of contraceptives including the IUD, the “morning-after pill” and Depo-Provera. Even hormonal contraceptives including oral contraceptives, patches and rings will thin the uterine lining preventing implantation. If interpreted as such, they will be outlawed. The only contraception that will probably remain will be condoms and we know how much men like to take a shower with a raincoat on….

– How can a physician surgically remove a tubal ectopic pregnancy thus terminating the life of an “embryo-person”? No, really, could someone tell me how a physician will be able to care for a patient with a life-threatening ectopic pregnancy?

– Are we really going back to the “good old days” when women were dying on a regular basis from botched backstreet abortions? Who will take care of the orphans?

Consequences to the Legal World

There are literally thousands of instances where the word “person” is written in the Mississippi statutes, each of which will have to be carefully reviewed to see how three-day old eight-cell stage embryos fit in. Think of the possible consequences:

– How will cryopreserved embryos inherit? Exactly what rights will they have?

– If embryos are created in Mississippi by a couple visiting from another state or another country, are they instantly going to be US citizens or citizens of the state of Mississippi?

– Will all embryos that do not survive have to undergo a burial? If they die unexpectedly, are they to undergo an autopsy?

– Women who smoke, drink in excess or use recreational drugs are at an increased risk for miscarriages. Are they to be charged with manslaughter or perhaps even murder if they are aware that their behavior could end the life of an “embryo-person”?

Disastrous Consequences to the Infertility Patient and Provider

It is clear that the proponents of initiative 26 feel the infertile patients are expendable. They don’t care that women and men’s lives and the families of Mississippi will be severely affected:

– Embryologists might be charged with manslaughter if embryos fail to survive in the laboratory.

– Will the laboratory even try to thaw frozen embryos understanding that at least 10-20% of them will not survive the thaw? Will the less expensive frozen embryo transfer procedures just disappear?

– If the physician transfers the embryos but the patient doesn’t conceive, will the physician be blamed? Will the doctor be accused of manslaughter for the failed implantation?

– Will frozen embryos be able to be moved outside of or into the state of Mississippi? Will Fedx take the chance of being accused of manslaughter should a transport tank fail in transit?

What will probably happen is that IVF will continue but physicians will only remove 2-3 eggs in a cycle. This will greatly increase the cost of the infertility treatment and result in much lower success rates. Those that can afford will go elsewhere. Who cares? For one, I do and I will bet every one of my patients will if Initiative 26 passes in Mississippi and they move on to other states, including Florida.

Well-Meaning Intentions With Unintended Consequences

This initiative is a really bad idea and has far more unintended consequences that I can even outline here in this short blog. The abortion decision is a personal decision between a woman, her partner, her conscience, her religion and her creator. We’ve been through this for years and years and the majority of Americans agree with this statement.

If Mississippians pass this law today, I know my work fighting the consequences of the Personhood Movement has just begun. Florida most likely will be one of the next states in their crosshairs. I will be forced to spend time, money and effort fighting these initiatives that I could otherwise devote to building families by encouraging the donation of unused embryos to patients in need. Instead of helping bring children into this world, I will be working diligently so I can prevent similar misguided political acts from destroying my patients’ dreams. Let’s hope the voters of Mississippi don’t find out too late that their actions have stymied the very goal they were trying to achieve – building loving families that would otherwise not exist.

I recently had the opportunity to be on Theresa Erickson's Internet radio show, Voice America. Known as the Surrogacy Lawyer, Theresa is renowned for her work on behalf of many patients faced with infertility looking for third party options. During my interview, we discussed the option of embryo donation from the physician, recipient and donor perspectives.

One of our donors, Tori, discussed her infertility experience as well as her and her husband's decision to donate their remaining embryos following a successful IVF procedure culminating in the delivery of her twins. You can see a picture of her twins and information regarding her amazing embryos by visiting our website.

Tori's Twins!

Tori and her husband decided that they wanted to “pay it forward” to other infertile couples. Here is a combination of her own words during the interview and some other comments she told me separately:

“Donating the embryos brought on a wide range of emotions; some expected such as the happiness to help another infertile couple, peace in setting the embryos ‘free’ by finally making a decision on their fate and others were a bit of a surprise such as a brief feeling of sheer panic that I ‘forgot’ something after leaving the clinic. The donation experience to me is like paying it forward to other infertile couples. I did not see any reason to leave the embryos suspended in time, did not want to see them destroyed and there was no reason to donate them to stem cell research when there are so many infertile couples in the world going through the same anguish I went through.

That feeling of anguish kept coming back, that longing and yearning for something that was so easy for others to have, yet so very difficult for me to obtain. I wanted to help someone relieve that awful feeling and by donating my embryos, I had a very good chance of doing just that.”

Tolisten to the show, please visit our Audio Gallery and click the play button to the right.

I am so thankful for people like Tori and other donors who consider giving their frozen embryos life while helping other people building their families at the same time. If you'd like more information on the process, please visit our embryo donation page on our Website, contact us at (239) 275-8118 or e-mail us at Fertility@DreamABaby.com.

Please stay tuned for the launching of our expanded embryo donation program called Embryo Donation International! I hope that many couples will consider to “pay it forward” just as Tori and her husband did.

Your thoughts and comments are always welcome.

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We have an update on a family featured in “The Fertility Chase” which aired on weTV (Women’s Entertainment) cable network in May. Guy Walter Costello was born on Father's Day, June 20, at 7:48 a.m., weighing seven pounds, four ounces. The proud parents, Amy and Walter Costello, tell us, “Guy is amazing and this whole experience has been so very special.” Click here to read more about the Costello family’s journey and their experience on “The Fertility Chase.” Congratulations to the proud new parents!

The staff at Specialists in Reproductive Medicine & Surgery is pleased to announce that Dr. Sweet has been named one of America’s “Top Doctors” in the field of reproductive endocrinology by research firm Castle Connolly Medical.

The “Top Doctors” are selected through a national survey of physicians and the medical leadership of leading hospitals. The physicians must meet certain criteria including a board certification requirement, a minimum number of years of unsupervised experience in their specialties and a clean disciplinary record.

Dr. Sweet is the only reproductive endocrinologist in Southwest Florida named to the “Top Doctors” list. Since 2004, Dr. Sweet has been recognized six times as the leading reproductive endocrinologist in Southwest Florida by Castle Connolly. The list of Lee, Collier and Charlotte counties’ top physicians are published annually in Gulfshore Life’s “Top Doctors” issue.

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Don’t forget – “The Fertility Chase” airs on this Saturday at 8:30 a.m. on WEtv. A story appeared this week in the Naples Daily News featuring a Naples couple’s journey through infertility: http://bit.ly/aG8fnk

Local fertility patients and physician, Dr. Craig R. Sweet, a reproductive endocrinologist and medical director of Specialists in Reproductive Medicine and Surgery, will be featured in a new independently produced television series “The Fertility Chase” scheduled to begin airing on May 1, 8:30 – 9 a.m. EST on WE tv, the Women’s Entertainment cable television network. The launch of the series, produced by Exodus Productions, coincides with National Infertility Awareness Week, April 24 – May 1, a week dedicated to raising awareness about infertility, a condition affecting 7.3 million Americans. The segment featuringSweet and his patients is scheduled to air on Saturday, May 15 and will highlight the issue of embryo donation.

One local couple featured in the show, Walter and Amy Costello from Sanibel, underwent in vitro fertilization following diagnosis and treatment for endometriosis, a leading cause of infertility. Under the care of Sweet and his staff, the couple implanted two embryos and chose to save their remaining four embryos to try for more children in the future or to donate to another infertile patient.

Through a process called cryopreservation or embryo freezing, excess embryos resulting from in vitro fertilization are stored for future use. An estimated 500,000 embryos are currently in cryopreservation in the United States.

“In addition to minimizing the opportunity for multiple births, cryopreservation gives families the opportunity to have more children in the future,” says Sweet. “In the event that patients choose not to transfer and use all of their remaining embryos, our patients are given the option to donate them to research or to other infertility patients who have chosen embryo donation to build their family.”

“In our case, we hope to use our embryos to grow our family someday,” says Amy. “However, should we decide not to do so, we have indicated our wishes to give the gift of life to another family through embryo donation.”

Less than two weeks after the Costello’s own embryos were implanted, the couple received long-awaited news: “We are expecting a baby boy, due on June 20, Father’s day,” says Amy. “It was a long, emotionally and financially difficult journey, but we couldn’t be happier. We are truly blessed.”

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Since the healthcare reform bill does not address specific diseases, infertility is not addressed in the bill. However, in 2014, small businesses and individuals will begin to purchase health insurance under the state-based American Health Benefit Exchanges so it may be included in these policies. Also in 2014, an “essential health benefits package” will be drafted. The intent is to include a comprehensive list of services, but it cannot be more extensive than a typical employer plan. Since this plan has not yet been drafted, the details are forthcoming.

Currently, several states have mandates requiring insurance coverage for the diagnosis and treatment of infertility. Florida is not among those mandated states. The plan does not specifically address state mandates so this will be an issue to watch.
On a positive note, the elimination of lifetime caps is a benefit for fertility patients. Patients who have a premature birth or need specific prenatal or neonatal care can often exceed the lifetime caps set by insurance companies.

In addition, the elimination of pre-existing conditions exclusion is also a plus for fertility patients. In some cases, patients have been denied coverage due to their pre-existing condition of infertility. Under the new reform bill, companies can no longer deny coverage based on pre-existing conditions.

The National Infertility Association, RESOLVE, has been monitoring the health reform discussions since they began and has met with Members of Congress to convey the needs of infertility patients in the U.S. While RESOLVE did not endorse any specific healthcare reform legislation, as a member of the National Health Council RESOLVE does support the Council’s Campaign to Put Patients First, a campaign which has identified five health care principles that must be part of meaningful healthcare reform. As the new reform law is implemented, RESOLVE will continue to advocate for the millions of Americans with infertility to ensure their voice is heard.
For more information on fertility treatments or health reform, visit www.dreamababy.com or call 239-275-8118.